Breast reconstruction using an implant

There are two main types of breast reconstruction: reconstruction using a breast implant and reconstruction using a woman’s own tissue. The aim of reconstructive surgery is to replace breast tissue lost during mastectomy or lumpectomy, restoring the breast shape. Doctors try to match as closely as possible the remaining natural breast by creating a breast ‘form’ with an implant which is placed beneath the skin and muscle that covers the chest, or by using muscle from another part of the body. A combination of these techniques is used in some women. Nipple reconstruction is also possible, usually as a separate operation once the reconstructed breast has settled into its final shape. Breast reconstruction can be done at the same time as the breast surgery, though is sometimes done some months or even years after the original operation. More medical information about breast reconstruction using an implant can be found on the Macmillan Cancer Support website.

A few of the women we interviewed had breast reconstruction using an implant. One of these women said she did a lot of research and discussed the different kinds of reconstruction with the breast care nurse before opting for an implant that would be gradually pumped up to size over time. She had reconstructive surgery at the same time as a mastectomy and was able to keep her nipple. Another said that she wished she’d had more information about the different kinds of reconstructive surgery and advised other women to find out as much as possible before making a decision. She had immediate reconstruction including removal of the nipple and insertion of a pre-filled implant. She had an infection in her reconstructed breast shortly after surgery but said she was now getting used to her new breast. She was also planning to have more surgery, including nipple reconstruction.

Pauline is a married teacher with one adult child.
Ethnic background / nationality' White British

I did a lot of research and felt that yeah I was going to have to go ahead. I had time with the breast cancer nurse to discuss whether I wanted a mastectomy without reconstruction or whether I wanted it with reconstruction and what type of reconstruction I wanted.

In the end I decided to go for an implant that was pumped up because I didn’t want to have the muscle taken from my back and brought round to the front. So by having a pumping up thing it means they just take the breast off and then they sew it up and it’s flat and then they gradually pump it up. And once it is the same size as your other breast, they then take that one out and replace it with an implant. And that’s stretched your skin, rather like when you’re pregnant, so it’s gradually getting bigger.

And I just felt that that was a better option because I really didn’t want my back interfered with as well as my front. So I choice that option. The other question I did ask was “Could I retain the nipple?” And I was told that, because the milk ducts go to the nipple, that there was obviously an element of risk if I left the nipple, so they would be taking the nipple as well, so I said “Fine.”

The night before I had the mastectomy the consultant did actually come and see me and say “Have we discussed nipples?” And I said “Yes we have” [laughs]. And he said “Well,” he said “I’ve been onto another hospital and they’ve had a lot of cases of DCIS and they have retained nipples.” And what they do is they give an extra blast of radiation, so he said, “You know, you can retain it if you want to.” Which left me in a bit of a quandary because I was being operated on the following morning. So I discussed it with my husband and I decided to keep the nipple.

When you saw the actual implant, was it what you expected? How did you feel?

Because I had this pump up version it was water, saline in it, so it was a bit like having a hot water bottle in your chest [laughs]. It was very odd because it rippled. But because I knew that was temporary, I don’t think I was worried one way or the other, you know, I didn’t, I just thought it’s there, you know.

How did it feel?

Just slightly watery and mobile. And of course because, one thing I was surprised at, you look like you’ve got an 18 year old breast because of course it’s nice and pert, so I do have lop sided breasts [laughs] but that has never really worried me, you know, it’s just one of those things.

But since the second implant, which is the silicone one, it’s a lot harder than I thought it would be, because when you feel it in your hand, it’s very malleable and very mobile, it feels like a breast. But of course once it’s in situ, because you’re then, it’s sort of put in like a pocket and it’s behind a muscle to keep it in place, it’s very hard and it’s not mobile at all, you know, it’s a bit like a tennis ball up your front, it is hard.

But that, as I say, it doesn’t worry me but wasn’t what I was expecting, I think that’s the difference, I thought I was sort of expecting the same as a normal breast but it’s not, it is a lot harder. And again like a 17 year old, you know, no sag [laughs].

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Profile Info

Age at interview:

51

Sex:

Female

Age at diagnosis:

50

Background:

Sandra is a married nurse with two children. Ethnic background / nationality' White British

This is the best I have felt consistently for at least two weeks now. And also I’m not sleeping any more during the day. I have much more energy. I feel much more better up here in my head. My implant, I’m not noticing it now. Also the swelling is at last really, really settling and it’s looking much more like my right breast.

My right breast is obviously lower, but the plastic surgeon has said he will re-arrange the furniture ‘cos I said I didn’t want an implant or anything in my right breast, but he said, “No, no, no, you don’t need that.” He said, “We’ll re-arrange the furniture, we take out tissue from the bottom, put it in the top and just shift the nipple up,” and he said they do that at the same time as having a reconstruction of the nipple ‘cos I have no nipple on the left breast. So I’m up, okay. And whether I’ve got used to it, whether because all the swelling has gone down, it definitely looks better.

I now, when I catch sight of myself in the mirror, I’m not having a double take now. My husband still hasn’t looked at it. He doesn’t like the thought, doesn’t like the thought of it at all. But he reassures me over and over, “I love you.” That’s lovely. But I’m getting, I’m much much more used to it now. And now that I don’t feel ill with breast implant infections anymore, now I want to keep it.

Several women said that, at a later date, they had the healthy breast lifted so that it would match the reconstructed one, known as a mastopexy. One woman, though, said she chose not to because she was happy with how she looked and didn’t want any more surgery.

Pauline is a married teacher with one adult child.
Ethnic background / nationality' White British

I’ve never worried about sort of physical appearance. I know I went for reconstruction but I mean again it’s become a bit of a standing joke because the surgeon always says to me “Now would you like anything done with the other side?” and I said “You’re giving me a complex” [laughs]. And he said “No, no, no I just don’t want you, you know, we can do it, if you would like the other side sort of made like the nice new side,” he said “we can do it.”

So I mean he’s just being extremely considerate and knowing that if I was unhappy about it, there is the option there. But quite honestly at my age, I just don’t see the point. And so I’m not worried about the fact that one side sags and the other side doesn’t. I mean it’s just unimportant because I don’t go around with no clothes on [laughs], and it looks fine with bras on, so it’s just not an issue. And I really wouldn’t want to go through an unnecessary operation, I would feel that was totally unnecessary.

I would be having an operation, again going back to sort of cosmetic vanity, and I don't know why. I would think God I’m taking huge risks purely for, what for? So for me that would, it’s not a problem. Now for somebody else it might be because we’re all different.

Yes. Are there any scars or anything on the reconstruction side?

I’ve got a scar at the top where I had the lumpectomies. The actual scar across the breast, I mean he’s an amazing surgeon, there is no, you just cannot see it, it is unbelievable and yet he cut right across the breast and you can’t see it. So really the only scar I’ve got that's visible is the one at the top, with the lumpectomies, and obviously because breast was actually taken out of there, there is pull there.

One younger woman with DCIS said she’d had an implant for nine years and it had boosted her confidence. She recently had a fall, though, which had affected the shape of her reconstructed breast and was thinking about whether to have the implant replaced.

Jacqui is a widowed teacher with two adult children.
Ethnic background / nationality' White British

I’ve actually still got the drainage tube in because I couldn’t face having more operations [laughs] to be honest and so they left that in. But unfortunately now it’s been in nine years. Just before Christmas I had a fall and after the fall the implant had started to go down. So I actually went to see the Consultant two weeks ago and I’ve got to go in a fortnight again because they are on about replacing the implant. Now I’m in two minds whether to have that done after reading information [laughs] on the internet, whether to, or have it taken out completely. I just don’t know what to do. The actual Consultant had signed me off for three years last time I went, this year. So I was really pleased about that.

I want to know whether with this one how long is it going to last. If I’m looking at having it replaced in another 15 years I’m going to be a lot older. I don’t want to be looking at that scenario really. To be honest I’ve thought about having it out completely, but my partner said for my own self esteem I ought to have it replaced. So I’m a bit confused about it at the minute. This is causing me some anxiety at the moment.

How do you think you will weigh that up? I mean, how do you feel, if you didn’t have it, how do you feel it might affect your self-esteem?

I think it will affect my self-esteem because of, having one for this long, for nine years, it’s, you know, I feel as if I’ve not lost a breast and to, and when I did lose my breast I had got that, say, what was it four weeks without a breast, I felt conscious if not … Some people don’t bother and I’m not being, that I’m, I think a lot about myself or anything [laughs] but I think it just did, this made me feel so much better, probably because I was younger…

So you’ve got a few weeks just to weigh out in your own mind?

Yes, yes.

And discuss it with the consultant. And if you go ahead with more surgery, would that happen quite quickly, or …?

I think so, yes, they are talking of doing it pretty quick, yes, but I don’t want to have extensive, I’m not bothered about having this attached to the nerve things, I’ve gone nine years with [laughs] it being numb, I can go again, yes.